What gets measured does not always get done
Authors: Jennifer L Kent, Patrick Harris, Susan Thompson
Journal: The Lancet Global Health (2022)

We commend the authors of the Lancet Global Health Series on urban design, transport, and health on the delivery of a comprehensive set of recommendations, which are relevant and useful. We have the greatest respect for their work in measuring the health impacts of urban form in various international contexts. We write as scholars of urban planning and public health policy and wish to draw attention to several concerns with the sentiment that "what gets measured, gets done".1Giles-Corti B Moudon AV Lowe M et al.Creating healthy and sustainable cities: what gets measured, gets done.Lancet Glob Health. 2022; 10: e782-e785Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar First, evidence is not enough. The health-promoting interventions and indicators described in the Series require changes to the systems shaping transport and urban outcomes. These systems are extremely vulnerable to the prevailing political economy. The Series shows how the standards currently applied in policy do not reflect those known to represent evidence-based best practice.2Lowe M Adlakha D Sallis JF et al.City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities.Lancet Glob Health. 2022; 10: e882-e894Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar There is obviously something more at play than data, and real-world examples abound of key actors in the policy-making process selecting evidence that supports political and institutional agendas.3Harris P Kent J Sainsbury P Thow AM Framing health for land-use planning legislation: a qualitative descriptive content analysis.Soc Sci Med. 2016; 148: 42-51Crossref PubMed Scopus (17) Google Scholar Second, the institutionalised focus in public health discourse on the quantification of outcomes is not benign. It provides a busy distraction from action to promote the development of urban areas that are supportive of human health. The need for deeper understandings of the political, economic, and regulatory barriers to change is urgent. This genre of research, however, is rarely funded by health agencies, which continue to prefer the collection of epidemiological data. The endless search for quantifiable evidence provides a point of procrastination for those with the power to take action. It also prevents the development of a nuanced understanding of the dynamics of policy making among the healthy cities research community.4Oliver K Cairney P The dos and don'ts of influencing policy: a systematic review of advice to academics.Palgrave Commun. 2019; 5: 1-11Crossref Scopus (112) Google Scholar Third, the intense focus on measurement ignores the fact that some aspects of the way cities shape behaviour, and how behaviour shapes cities, cannot be quantified.5Cameron WB Informal sociology: a casual introduction to sociological thinking. Random House, Chicago, IL1966Google Scholar There are many diverse, effective, and rigorous methods available to social and health scientists that can be deployed to understand complex problems. This option has been recognised by practitioners in the implementation of cutting-edge concepts such as wellbeing budgets, which value qualitative and quantitative data.6Anderson M Mossialos E Beyond gross domestic product for New Zealand's wellbeing budget.Lancet Public Health. 2019; 4: e320-e321Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar The focus of the research discourse, however, is lagging behind. To limit our understandings through an overwhelming concentration on quantification restricts our understandings to occurrences that can be measured. This approach misses the sheer complexity of lives lived in 21st century urban spaces across the globe. In summary, health research that promotes measurement alone as a legitimate pathway to decision making is problematic. Evidence is necessary, but it is just one component of policy decision making. Measuring gets published, but it does not necessarily get things done. JLK received funding to their institution from the Australian Research Council and is a member of the Health Planning Expert Working group NSW. JLK sits on the board of the Australasian Transportation Research Forum and the World Society for Transport and Land Use Research. PH reports receiving funding to their institution from the Australian National Health and Medical Research Council and the Australasian Housing and Urban Research Institute. ST reports receiving funding to their institution from the Australian National Health and Medical Research Council and the Australian Research Council and is a member of the Healthy Planning Expert Working Group and the International Society of Urban Health Expert Advisory Council. Creating healthy and sustainable cities: what gets measured, gets doneSince the first Lancet Series on urban design, transport, and health (Series 1) was published in 2016, the urgency to make the transition to healthy and sustainable cities worldwide has intensified. That year, the UN's Sustainable Development Goals1 for promoting prosperity while protecting the planet and ensuring equity came into force. WHO also released its Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. At WHO Global Conference on non-communicable diseases (NCDs) in 2017, heads of states reiterated their commitment to reduce premature mortality from NCDs by a third by 2030. Full-Text PDF Open AccessCity planning policies to support health and sustainability: an international comparison of policy indicators for 25 citiesCity planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Full-Text PDF Open AccessWhat gets measured does not always get done – Authors' replyIn their Correspondence, Jennifer Kent and colleagues have concerns about the sentiment "what gets measured, gets done" expressed through the title of the lead Comment in the Lancet Global Health Series on urban design, transport, and health1 "promotes measurement alone as a legitimate pathway to decision making". Full-Text PDF Open Access